BASICS
Medicare Advantage plans are also known by this name
What is Medicare Part C
Overview of plan information, recommended for plan presentations
What is the Summary of Benefits (SOB)
Maximum amount a beneficiary will pay for medical services
What is MOOP?
Prospects must have this to enroll into a MA/MAPD/PDP plan
What is HMO (Health Maintenance Organization)?
This is a government health insurance for people 65 and older or ESRD or disability 24 months or longer
What is Medicare?
Benefits often included in a Medicare Advantage plan, abbreviated by DVH
What is Dental, Vision and Hearing?
Beneficiary will pay the full cost of service till its met
What is deductible
Used to send emails with plan information to beneficiaries
What is Think Agent
This type of plan is designed for people who qualify for both Medicare and Medicaid.
What is a DSNP (Dual Eligible Special Needs Plan)?
Portion of Medicare that covers Hospital, Hospice and skilled nursing care.
What is Medicare Part A
This type of care is always covered in Medicare Advantage plans, even with traveling.
What is emergency or urgent care?
Cost Beneficiary will pay instead of set copay
What is coinsurance?
Begins January 1st and ends March 31st. A person is eligibile to use this only if they are currently enrolled in a MA/MAPD plan
What is MA-OEP
Aetna plan typically offered to Veterans because does not include prescription drug coverage
What is Aetna Medicare Eagle Plan
Plan by a private insurance company that covers everything Medicare Part A&B cover, plus additional benefits Original Medicare does not cover.
What is MAPD?
Aetna Medicare Advantage plans offer this wellness benefit to help members stay active and healthy.
What is a fitness program or gym membership (SilverSneakers)?
beneficiary pays as their contribution for medical services or prescriptions
What is cost share
Prospects that have both Medicare and Full Medicaid and have a FIDE/HIDE plan available in their area can use the Integrated SEP to enroll into a FIDE/HIDE DSNP. Except this level, who although they may qualify to enroll into a FIDE/HIDE DSNP plan, can not use that monthly integrated SEP to do so.
Who is QMB?
This combines benefits of HMO and PPO plan types
What is a HMO-POS
To enroll into as MA/MAPD, you must first be enrolled into these 2 parts of Medicare.
What are Part A&B?
Callers with Extra Help/LIS may qualify for additional benefits through this, like $0 Part D drugs and an allowance for healthy foods, OTC, utlitities, personal care supplies, and transportation on the Extra Supports Wallet.
What is the Aetna Assist Program (AAP)?
Susan's monthly plan premium is $59.00. She has a Medicare deductible of $700 and a MOOP of $3,600. Her Primary care visits have a copay of $10. What is the most Susan will pay for covered services before the plan will pay 100% of the cost?
What is $3600?
This part of the enrollment process allows beneficiary to choose method and subject of communications
What are marketing questions?
These are available in 3 metro-areas, Chicago, Pittsburgh, Philedelphia and are designed for members with diabetes, chronic heart failure and/or cardiovascular disease. They have benefits tailor-made to support these conditions.
What are CSNPs